Around one in three nurses in general practice feel they are not working to full scope.
Up to 29% of nurses in general practice believe they are not regularly or often working to their full scope of practice, a sign which the Australian Primary Health Care Nurses Association (APNA) says may threaten workforce stability.
In response to a survey of over 2000 primary healthcare nurses conducted by APNA, one in 10 general practice nurses said that multidisciplinary care planning and delivery were not encouraged or supported at their practice.
Another key finding from the survey, APNA president Denise Lyons told The Medical Republic, was that nurses who were unable to work to their full scope of practice were more likely to leave the profession.
“It’s frustrating to have capabilities and not be able to utilise those,” she said.
Often, Ms Lyons said, the main barrier to nurses working to full scope was structural.
For instance – some nurses are authorised immunisers. It would be perfectly legal for them to independently authorise and administer a vaccine.
The constraint, though, is that the MBS does not provide funding for this activity unless there is a GP present.
Ms Lyons stressed that APNA wasn’t necessarily advocating for nurse-led MBS items or even nurse access to existing MBS items.
“It’s more about looking at other, different ways of funding primary care that enable the multidisciplinary team members to do what they are trained to do,” she said.
“And I think there’s pretty universal agreement that the fee for service model isn’t [sustainable].”
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The exact model endorsed in the 2024 scope of practice review final report was a new blended payment model that would move general practice payments from 90% fee-for-service to 60%, effectively reducing a total reliance on the MBS for funding.
Part of the transition plan includes investing in nurse-led multidisciplinary clinics for rural areas.
The ACT is one of the only jurisdictions to fund nurse-led clinics in Australia. A 2024 Canberra Times investigation found that each consult at one of the clinics cost territory taxpayers roughly $190.
The scope of practice review also recommended pushing ahead with plans to expand prescribing rights to some registered nurses.
Work on this is still underway, with legislation before the House of Representatives which – if passed – would allow qualified nurse prescribers to write PBS-eligible scripts, so long as they have an arrangement in place with another PBS approved prescriber.
Pending the passage of legislation, it’s expected that the first registered nurse prescribers will gain their qualifications in late 2027.
“Nurses are … the largest workforce in primary healthcare,” Ms Lyons said.
“Some of the structures that are in place now lead to a huge missed opportunity.
“We know we have workforce shortages, rising demand and an ageing population, and we have skilled nurses ready, willing and able to do more.”
